This Week with the NYS WCB

Here is a review of relevant Board Panel Decisions filed this past week: (1) Consequential Exacerbation This claim is established for bilateral ankles and the lower back due to a 2015 accident.  The indemnity portion of the claim was settled in 2018, leaving the medical portion open. A C-4AUTH for a left ankle CT-scan was filed in March of 2020, which the carrier granted.  A subsequent C-4AUTH for the same text was filed in November of 2020, but denied by the carrier due to a new accident, since the supporting medical report described a new accident occurring in October of 2020. At a hearing, claimant testified to a fall occurring on August of 2020 while walking from his garage to his house, when he lost his balance.  Claimant argued that this fall was consequential, since the loss of balance was due the established injuries, and reference the previously-granted C-4AUTH.  The carrier argued that this was a new and superseding accident, and that the prior C-4AUTH was ...

Last week, the Third Department decided only one case on appeal from the Board, but it's worth reviewing. Gaylord v. Buffalo Transportation, Inc., Southeast Personnel Leasing, Inc. and WCB . Decided June 10, 2021. Claimant, a bus driver for Buffalo Transportation Inc., was injured in an accident on February 9, 2018.  He filed a claim, stating that Buffalo Transportation was his employer.  Beforehand, that employer entered into an employee leasing agreement with Southeast Personnel, a professional employer organization (PEO).  Under the agreement, this PEO assumed several human resources responsibilities, including the procurement of workers' compensation insurance for "worksite employees . . . either in its own name" or in Buffalo Transportation's name, per statutes governing PEO's.  NY Labor Law 916; 922.  The PEO obtained a policy from State National Insurance Company which covered the date of accident. State National controverted this claim, arguing that cl...

 Here are some recent Board Panel decisions of note: (1)  Transitional Housing This claim was established for the left shoulder, consequential CRPS, and depression for a 2002 accident.  Claimant was classified with a permanent total disability in 2011.  A few months before that finding, assisted living was authorized, and the SIE was directed to reimburse claimant for those expenses. A 2020 IME revealed that claimant suffered from an unrelated psychosis.  Claimant was hospitalized for this condition in 2019, and after refusing placement in the city mission, was instead discharged to Homewood Suites.  At the time of the IME, claimant was looking for placement in a new assisted living facility.  The IME physician found that claimant's need for assistance with daily activities was only 25% causally related and 75% due to the unrelated psychiatric conditions. Claimant sought reimbursement for nursing and companion aide services during his stay at Homewood ...

 Good Evening All.  Here are some Board Panel Decisions handed down before Memorial Day. (1)  Pre-Classification Attachment This claim is established to the right leg and left foot, PTSD, depression, and CRPS of the right shin from  a 2005 accident. After the record was nearly fully developed as to permanency, the carrier raised the issue of labor market attachment, since claimant had been receiving a temporary partial rate.  The Law Judge held that the issue of LWEC would be postponed until after the COVID-19 pandemic restrictions were lifted.   On appeal, claimant's counsel raised laches, as attachment was not raised previously.  The Board Panel took note of the fact that attachment would not be addressed during the COVID pandemic, as well as the fact that the 2017 Amendments no longer required classified claimants to demonstrate attachment.  However, since the claimant was not yet classified, and the carrier appropriately raised attachment...